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MSK Flashcards

1
Q

Which part of the join becomes infected in septic arthritis?

A

joint space

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2
Q

what age does septic arthritis commonly occur?

A

<2yrs

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3
Q

how can septic arthritis occur?

A

usually - haematogenous spread
puncture wound
infected skin lesions
adjacent osteomyelitis

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4
Q

What are the most common causative organisms of septic arthritis?

A

staph. aureus

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5
Q

What are the signs/sx of septic arthritis?

A 
limp/pain referred to knee
red hot tender joint 
reduced ROM
febrile 
pseudo paresis
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6
Q

What is the criteria used to diagnose septic arthritis?

A

kosher:
fever >38.5
Non-weight bearing
Raised ESR + WCC

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7
Q

What is the definitive investigation for septic arthritis?

A

joint aspiration and culture

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8
Q

What are other investigations for septic arthritis?

A
  1. FBC - WCC, ESR/CRP
  2. blood cultures
  3. us of deep joints - joint effusion
  4. XR - normal in SA but will exclude trauma and bony lesions
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9
Q

What is the management of septic arthritis?

A
  1. IV flucloxacillin or clindamycin
  2. Joint wash out/ surgical drainage
  3. Keep joint immobilised in functional position at first then mobilise to prevent deformity
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10
Q

What is juvenile idiopathic arthritis defined as

A

persistent joint swelling >6 weeks presenting before 16yrs in absence of infection or any other cause

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11
Q

What are the subtypes and how are they classified?

A 
→      Oligoarthritis = ≤4 
→	Polyarthritis = >4 joints
→	Systemic = incl. fever and rash 
→	Psoriatic 
→	Enthesitis
→	Subtyping further classified according to the presence of rheumatoid factor and HLA B27 tissue type
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12
Q

What are the symptoms of JIA?

A

Gelling
morning joint stiffness
pain
fever

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13
Q

What are signs of JIA in young child

A

intermittent limp
deterioration in behaviour/mood
avoiding fun activities

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14
Q

What is the cause of eventual swelling in JIA?

A

Joint effusion
inflammation
chronic due to proliferation of synovium

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15
Q

What are the effects of long term uncontrolled JIA?

A

bone expansion from overgrowth causing
valgus deformity
leg lengthening
discrepancy in digit length

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16
Q

What indicates sepsis or malignancy as a cause as opposed to JIA?

A

systemic features

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17
Q

What is the pharmacological management of JIA?

A
  1. NSAIDs, analgesics to relieve sx
  2. Joint injections
  3. Methotrexate
  4. systemic corticosteroids
  5. cytokine modulators e.g. TNF alpha blockers
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18
Q

What is important to monitor when giving methotrexate and why

A

regular bloods due to abnormal LFTs and bone marrow suppression

19
Q

What are the complications of JIA?

A
  1. chronic anterior uveitis (visual impairment)
  2. flexion contractures of joints
  3. Growth failure
  4. Constitutional problems (anaemia, delayed puberty)
  5. osteoporosis
  6. Amyloidosis (rare)
20
Q

What can be done to reduce risk of osteoporosis inJIA?

A

Dietary supplements of calcium and fit D
regular weight bearing exercise
minimal oral CS use
bisphosphonates???

21
Q

Why is growth failure a complication of JIA?

A

anorexia, chronic disease and systemic CS therapy

22
Q

What joints are commonly affected in oligoarthritis in JIA?

A

Knee
ankle
wrist

23
Q

What is Perthes disease?

A

avascular necrosis of the capital femoral epiphysis of the femoral head to to interruption of the blood supply
followed by revascularisation and reossification over 18-36m

24
Q

When does Perthes disease commonly present?

A

5-10yrs

25
Q

What gender is perthes more common in and by how much?

A

boys 5x

26
Q

What is the presentation of perthes disease? give the nature of onset

A

insidious
LIMP
hip/knee pain
stiffness, reduced ROM

27
Q

What can perthes disease be confused w ?

A

transient synovitis

28
Q

What are ix for perthes disease, what will they show?

A

Hip XR
early sign: increased density of femoral head
then becomes fragmented and irregular

29
Q

What is the management of early perthes disease

A

bed rest and traction

30
Q

What is the management of later perthes disease?

A

cover femoral head in acetabulum by maintaining hip in abduction
joint replacement due to risk of arthritis

31
Q

What indicates a good prognosis of perthes disease?

A

younger (increased ability to remodel)

32
Q

What is SCFE

A

slipped capital femoral epiphysis

33
Q

Who is SCFE more common in?

A

10-15 yrs

obese boys

34
Q

/What is SCFE associated w

A

metabolic endocrine abnormalities

e.g. hypothyroidism + hypogonadism

35
Q

What is the presentation of SCFE

A

Either: acute or chronic
LIMP
hip pain (can be referred to knee)

36
Q

what is found on examination in SCFFE?

A

restricted abduciton and internal rotation of the hip

37
Q

How is SCFE diagnosed? what sign is seen?

A

Hip XR - trethowans sign

38
Q

What is the management of SCFE?

A

Surgical pin

39
Q

What is osteogenesis imperfecta also known as?

A

brittle bone disease

40
Q

What is type 1 osteogenesis imperfecta? give the features

A

the milder and more common form
fractures during childhood
blue sclerae
some have hearing loss

41
Q

What is type II osteogenesis imperfecta?

A

severe and lethal
multiple fractures before birth
many stillborn

42
Q

What type of inheritance is osteogenesis imperfecta?

A

autosomal dominant

43
Q

What is the underlying pathology of osteogenesis imperfecta?

A

disorder of collagen metabolism leading to bone fragility, bowing and frequent fractrues

44
Q

What is the treatment of type I osteogenesis imperfecta

A

bisphosphonates

splinting of fractures to minimise joint deformity

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